Electronic health records (EHRs) are here to stay. The industry has come to accept this and more smaller and medium-sized medical practices have recently begun to implement an EHR. Those who have held off are wondering about whether such a substantial investment will pay off -- both in terms of dollars and patient care.
Money in the Bank
Unless you’ve been on another planet for the past year, you are likely aware that the government is going to pay up to $44,000 over five years per eligible provider for “meaningful use of certified EHR technology.” The incentive plan was introduced as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, included in the massive stimulus bill that was signed into law in February of 2009. The Medicare and Medicaid incentive payments will help cover initial EHR set-up fees and training time in most cases, but some practices are still wondering about the potential for longer-term gains associated with EHR adoption.
“You’re not buying an EHR to receive the HITECH incentives,” said Don Fornes, CEO of Software Advice, a free online site matching software needs with quality products. “You’re buying an EHR to help you manage your practice more effectively, improve patient care and reduce costs. The five-year savings of a full EHR implementation ($151,620) far outweigh the HITECH incentives ($44,000) over the same time period.”
Obvious savings from an EHR implementation include less money spent on things like transcriptions and chart pulls (and their associated labor costs) and reductions in storage space and supplies when paper records are eliminated.
In addition to saving money by going paperless, practices that implement an EHR can also anticipate to improve their reimbursements – and gain revenue -- through improved billing practices. For instance, where the tendency by many providers may be to use a lower coding level to minimize audit risk, EHRs facilitate the use of higher Evaluation and Management (E&M) coding levels by allowing for better and more complete documentation of care, and by containing functionality that suggests the most appropriate code for services rendered. Enhanced documentation also helps providers eliminate missed or overlooked charges that may adversely impact reimbursement rates. Revenue increases from more efficient billing has been documented in case studies by the Health Information Management Systems Society (HIMSS) and the American Academy of Family Practitioners (AAFP) that demonstrate a revenue increase of up to 5 percent from better use of E&M codes provided through an EHR, and in some cases an average billable gain of $26 per patient visit.
A growing body of research also suggests that EHRs can help practices avoid expensive malpractice suits, which can cost hundreds of thousands of dollars. Clearer and more centralized documentation of a patient's medical history in an EHR offers a stronger defense in medical liability claims. Better documentation, and built in alerts about things like drug allergies and interactions, and notifications from the government about drug warnings or recalls help foster patient safety – and reduce liability.
Finally, all of the added efficiencies from EHR use lead to increased productivity and enable providers to see more patients in a day – which means more revenue in the door.
Improving Patient Care
Medical practices are, after all, businesses, and providers and office managers realize that they have to be profitable to keep doors open. But in addition to boosting a practice’s bottom line, EHRs can also have a vast impact on patient care.
“Digitizing our records made a world of difference in the way that we managed our practice,” said Heather Brown, a registered nurse who implemented NueMD EHR for a podiatry office in Melbourne, Fla. “We not only became more efficient, but we were also able to be more targeted in our diagnoses and patient education efforts.”
One of the biggest enhancements from EHR adoption stems from a more data-driven approach to practice and patient management. There are tools included within NueMD – and most EHR systems – that allow for easy benchmarking, so users can compare clinical data of individual patients to national care standards, or to other patients within the practice. Having structured data contained within an electronic environment also helps providers better monitor patient groups that share a disease or diagnosis (e.g. all patients with hypertension) to draw conclusions about the overall care of that population, communicate specifically to that group, or determine where to direct patient education efforts.
Another benefit of EHRs is that they foster interoperability – or allow all stakeholders in a patient’s care (doctors, nurses, pharmacists, radiologists, laboratory, etc.) to easily share patient information electronically. Broader access to a patient record helps to eliminate duplication and cut down on paperwork –which ultimately speeds a patient encounter. This clinical connectivity also can reduce medical errors, as clinicians have better access to decision support, and functionality like Computerized Physician Order Entry (CPOE), which allows a provider to electronically communicate treatment instructions, and helps prevent errors that result from insufficient knowledge or incomplete clinical information at the time of the encounter.
EHRs can also help practices streamline their workflow, as practice staff spend less time doing things like retrieving charts, and more time on the actual patient encounter. Specifically, EHRs prevent duplication of tasks, and allow providers to work concurrently to coordinate care. They also decrease the time needed to share information with other clinicians, and give providers the ability to access charts remotely.
Finally, by automating a practice with an EHR, patient satisfaction will increase as providers get faster access to their records, and they experience faster turn around time for things like medication refills.
Electronic Health Records can be a big financial and human resource investment for a medical practice. Users can expect a steep learning curve as they adapt to a new workflow and different processes that go hand in hand with automation. But over time, the vast majority of practices that adopt and fully implement an EHR are likely to become more efficient and productive, which can mean more money in the door, and happier, more satisfied patients.
For more information, check out "Value Measurement and Return on Investment for EHR" from Virtual Medical Worlds Monthly.